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Tap your hand if you feel the beat: differential effects of tapping in melodic intonation therapy
Aphasiology
Abstract
Background: Melodic Intonation Therapy (MIT) is a structured, intensive therapy for recovery of verbal output in people with nonfluent, Broca’s type, aphasia. Stemming from the observation that people with nonfluent aphasia can sometimes sing fluently, MIT was developed with two distinctive “musical” features. The first is intonation of phrases, typically over a two-pitch interval, in a chant-like connected form. The second is pacing syllable initiation with a steady rhythmic tapping of the client’s hand on a table.
Aims: Research has suggested that people with aphasia may have a higher-than-typical prevalence of rhythm processing deficits. The present study investigates whether these deficits might affect therapeutic results from MIT. We hypothesized that a comparison of treatment with and without tapping would show positive treatment effects from the inclusion of tapping. We further hypothesized that the effect of tapping may be different, or even opposite, for people with rhythm processing deficits.
Methods & Procedures: The study included three participants who underwent treatment with MIT in two 5-week treatment blocks: one with tapping, and one without. Three sets of phrases were balanced for phonetic complexity, syntactic structure, and baseline performance. A set was assigned to each treatment condition, and the third set remained untrained. Spoken repetition ability across all sets was tested at baseline, between blocks, at the close of therapy, at 5-week follow up, and in probes each week throughout treatment. Propositional speech was also assessed at baseline and milestone testing points.
Outcomes & Results: Results showed that two participants who were assessed as having an intact ability to tap to the beat of music – intact entrainment – realized stronger treatment effects with rhythmic tapping. The third participant, who was assessed as having impaired entrainment, showed greater treatment effects from treatment without tapping.
Conclusions: These results suggest that testing individual MIT candidates for the ability to tap along to music, and modifying clinical treatment protocols accordingly, may result in greater therapeutic effectiveness of MIT for entrainment-impaired clients.
... In this series of papers, aphasia therapies have been first subdivided into approaches that primarily focus on neurobiological foundations of language processing, 19 functional communication processes, 20 or cognitive-linguistic processes. The present paper explores the application of the RTSS framework to a variety of cognitive-linguistic aphasia treatments as implemented in five recent treatment studies: Semantic Feature Analysis, 21 Melodic Intonation Therapy, 22 Brain Budget Protocol, 15 Treatment of Underlying Forms, 13 and Structural Priming 14 (see Table 2). These treatments have been chosen because they vary along linguistic levels (words, phrases, sentences) as well as other linguistic and cognitive factors (e.g., the role of implicit vs explicit processing). ...
... A sample fluency treatment (Melodic Intonation Therapy) Melodic Intonation Therapy 51,52 is a long-standing treatment of nonfluency in aphasia, which involves the repetition of sentences using a hierarchy of cues designed to scaffold the fluency of spoken language production. Active ingredients include the use of simplified and exaggerated intonation patterns and the use of rhythmic hand-tapping matching the beat-pattern of the sentence 22 . ...
... Curtis and colleagues 22 examined the influence of one MIT ingredient, hand-over-hand tapping, by comparing standard MIT to MIT without hand-tapping in three individuals with aphasia in a single-subject counterbalanced design. Specific MoAs were not explicitly hypothesized, although the authors proposed that rhythm might have an "unblocking effect". ...
The Rehabilitation Treatment Specification System (RTSS; Van Stan et al., 2019) provides a framework to identify specific components of treatments developed within various rehabilitation disciplines (e.g., physical, occupational, or speech-language therapy). Furthermore, this framework offers the opportunity to identify the target and active ingredients of a therapy approach as well as the mechanism of action by which it is hypothesized to effect change in abilities or functions. In this paper, we apply the RTSS framework to the characterization of a sample of treatments for aphasia that are based on cognitive-linguistic models of language processing. Our discussion of these applications centers on the benefits of this classification system as well as additional criteria to consider when evaluating cognitive-linguistic treatments for aphasia.
... En outre, il a été montré que les patients sont satisfaits de cette approche, puisque celle-ci leur « donne l'impression de parler », ce qui est apprécié par les patients atteints d'aphasie non fluente [38]. Cette méthode présente également des avantages en termes d'engagement des patients. ...
... Cependant, cette méthode présente des inconvénients, tels que la nécessité d'une intensité importante des séances, l'utilisation de ressources importantes lors de la thérapie et les risques lors de la prédiction de l'effet de la méthode pour chaque patient. La personnalisation de la thérapie à chaque patient, en fonction de ses troubles et ses compétences, permettrait d'optimiser l'efficacité et d'assurer une meilleure récupération [38]. ...
La rééducation du langage et de la parole dans le cadre de l’aphasie post-AVC est fondamentale pour aider le patient à retrouver ses capacités de communication, ainsi que son insertion familiale, sociétale et professionnelle. Cependant, en phase chronique, l’efficacité de la méthode classique de rééducation, la méthode orthophonique, diminue et l’accès aux soins se complique dû aux limites géographiques, financières et liées à la santé des patients. Ainsi, de nouveaux
programmes de rééducation combinant la rééducation classique avec de nouvelles approches de rééducation, semblent nécessaires. Dans cette brève revue, nous présenterons de telles méthodes potentiellement utiles dans l’aphasie chronique, telle que la thérapie par contrainte induite, la thérapie musicale et les méthodes technologiques (télé-rééducation).
Nous postulons qu’afin de choisir le programme de rééducation le plus adapté, il convient de respecter trois principes : l’intensité (appliquer une rééducation intensive), l’engagement social (favoriser les interactions sociales et la communication) et la personnalisation (s’adapter aux compétences des patients et prendre en compte leurs objectifs de récupération). Nous proposons un programme de rééducation qui combine la rééducation classique et la télé-rééducation (rééducation en autonomie, via des applications sur ordinateur ou tablette). Ce programme présente de nombreux avantages : augmentation de l’intensité de la rééducation, favorisation de l’engagement social avec l’implication de l’entourage, et adaptation aux difficultés du patient et aux compétences qu’il ou elle souhaite améliorer.
Speech and language rehabilitation in post-stroke aphasia is fundamental to help patients regain their communication skills, as well as their family, social, and professional integration. However, in the chronic phase, the effectiveness of the classic rehabilitation method (the speech therapy method) decreases and the access to care becomes more complicated due to geographical, financial, and health-related limitations. Thus, new rehabilitation programs combining conventional rehabilitation approaches with new ones seem to be necessary. In this brief review, we will present several potentially useful methods in chronic aphasia, such as induced constraint therapy, music therapy, and technological methods (telerehabilitation).
... Acknowledging that dimensions of fluency may fractionate at the individual level will also facilitate goal setting in aphasia therapy. To put this in terms of the Rehabilitation Treatment Specification System (Fridriksson et al., 2021;Zanca et al., 2019), treatment should be based on a theory of therapy that identifies targets (e.g., increased fluency), ingredients of the treatment approach (e.g., elements of Melodic Intonation Therapy: Albert et al., 1973;Curtis et al., 2020;or entrainment: Fridriksson et al., 2012;Kershenbaum et al., 2023), and mechanisms of action through which ingredients are hypothesized to achieve targets. Understanding the source or mechanism of breakdown in a given individual is essential to proposing methods by which the deficit may be remediated, and this allows the clinician to make appropriate decisions about treatment targets and ingredients. ...
Purpose
Assessing fluency in aphasia is diagnostically important for determining aphasia type and severity and therapeutically important for determining appropriate treatment targets. However, wide variability in the measures and criteria used to assess fluency, as revealed by a recent survey of clinicians (Gordon & Clough, 2022), results in poor reliability. Furthermore, poor specificity in many fluency measures makes it difficult to identify the underlying impairments. Here, we introduce the Flu-ID Aphasia, an evidence-based tool that provides a more informative method of assessing fluency by capturing the range of behaviors that can affect the flow of speech in aphasia.
Method
The development of the Flu-ID was based on prior evidence about factors underlying fluency (Clough & Gordon, 2020; Gordon & Clough, 2020) and clinical perceptions about the measurement of fluency (Gordon & Clough, 2022). Clinical utility is maximized by automated counting of fluency behaviors in an Excel template. Reliability is maximized by outlining thorough guidelines for transcription and coding. Eighteen narrative samples representing a range of fluency were coded independently by the authors to examine the Flu-ID's utility, reliability, and validity.
Results
Overall reliability was very good, with point-to-point agreement of 86% between coders. Ten of the 12 dimensions showed good to excellent reliability. Validity analyses indicated that Flu-ID scores were similar to clinician ratings on some dimensions, but differed on others. Possible reasons and implications of the discrepancies are discussed, along with opportunities for improvement.
Conclusions
The Flu-ID assesses fluency in aphasia using a consistent and comprehensive set of measures and semi-automated procedures to generate individual fluency profiles. The profiles generated in the current study illustrate how similar ratings of fluency can arise from different underlying impairments. Supplemental materials include an analysis template, extensive guidelines for transcription and coding, a completed sample, and a quick reference guide.
Supplemental Material
https://doi.org/10.23641/asha.27078199
... MIT was proposed as a multimodal and interactive intervention approach to promote connected speech production in individuals who present with significant pausing, articulation difficulties, and poor repetition in the presence of relatively intact auditory processing and comprehension, along with left-lateralized lesions (Helm-Estabrooks et al., 1989). Improved behavioural outcomes in nonfluent patients following MIT have been reported throughout the literature (Belin et al., 1996;Conklyn et al., 2012;Curtis et al., 2020;Norton et al., 2009;Sparks et al., 1974). However, for people with chronic aphasia, gains are often limited to trained utterances with weak evidence for generalization, while generalization is more often observed in people in the subacute phase (Popescu et al., 2022;Van Der Meulen et al., 2012Zipse, accepted). ...
It is unclear whether individuals with agrammatic aphasia have
particularly disrupted prosody, or in fact have relatively
preserved prosody they can use in a compensatory way. A
targeted literature review was undertaken to examine the
evidence regarding the capacity of speakers with agrammatic
aphasia to produce prosody. The aim was to answer the
question, how much prosody can a speaker “do” with limited
syntax? The literature was systematically searched for articles
examining the production of grammatical prosody in people
with agrammatism, and yielded 16 studies that were
ultimately included in this review. Participant inclusion
criteria, spoken language tasks, and analysis procedures vary
widely across studies. The evidence indicates that timing
aspects of prosody are disrupted in people with agrammatic
aphasia, while the use of pitch and amplitude cues is more
likely to be preserved in this population. Some, but not all, of
these timing differences may be attributable to motor speech
programming deficits (AOS) rather than aphasia, as these
conditions frequently co-occur. Many of the included studies
do not address AOS and its possible role in any observed
effects. Finally, the available evidence indicates that even
speakers with severe aphasia show a degree of preserved
prosody in functional communication.
... MIT was proposed as a multimodal and interactive intervention approach to promote connected speech production in individuals who present with significant pausing, articulation difficulties, and poor repetition in the presence of relatively intact auditory processing and comprehension, along with left-lateralized lesions (Helm-Estabrooks et al., 1989). Improved behavioural outcomes in nonfluent patients following MIT have been reported throughout the literature (Belin et al., 1996;Conklyn et al., 2012;Curtis et al., 2020;Norton et al., 2009;Sparks et al., 1974). However, for people with chronic aphasia, gains are often limited to trained utterances with weak evidence for generalization, while generalization is more often observed in people in the subacute phase (Popescu et al., 2022;Van Der Meulen et al., 2012Zipse, accepted). ...
Purpose
Unison production is a common aphasia treatment technique in which the clinician and the person with aphasia (PWA) produce phrases aloud together. It can be implemented using a typical “conversational,” syntax-influenced prosodic timing structure, or with a “metrical,” beat-based timing structure, but to date no study has directly compared these two approaches. This study compared the effects of metrical versus conversational prosodic timing during unison production on the (a) accuracy of participants' spoken output and (b) timing alignment of participants' productions with the stimuli.
Method
PWAs and controls listened to conversationally timed and metrically timed sentences and repeated them in unison with audio recordings. Productions were transcribed and scored in two ways: (a) Accuracy was calculated as the percentage of correctly produced syllables, and (b) timing alignment was determined by extracting the voice onset moment of identical target syllables in the unison stimuli and participant productions in both conditions and comparing the corresponding time points.
Results
Metrical timing yielded a greater number of accurate syllables in both groups, with larger effect in PWAs than in controls. Both groups exhibited more anticipatory, less variable timing when speaking along with metrical stimuli, though evidence of such prediction was also present in the conversational condition.
Conclusions
Results suggest that unison production works via entrainment—a process that utilizes prediction to guide synchronous production of spoken output. Metrically regular stimuli may facilitate this process as they are more rhythmically predictable. Future work will examine key behavioral variables that predict benefit from unison production and metrical timing.
... Importantly, a better understanding of rhythmic perception and production in aphasia can guide language treatment candidacy, especially for rhythm-based interventions. For example, Curtis et al. (2020) reported that PWA with better rhythmic abilities were more likely to benefit from an additional rhythmic cue (hand tapping) in response to melodic intonation therapy. Similarly, Stefaniak et al. (2021) found a correlation between the perception of rhythmic patterns and picture description fluency in PWA. ...
Introduction
People with aphasia have been shown to benefit from rhythmic elements for language production during aphasia rehabilitation. However, it is unknown whether rhythmic processing is associated with such benefits. Cortical tracking of the speech envelope (CTenv) may provide a measure of encoding of speech rhythmic properties and serve as a predictor of candidacy for rhythm-based aphasia interventions.
Methods
Electroencephalography was used to capture electrophysiological responses while Spanish speakers with aphasia (n = 9) listened to a continuous speech narrative (audiobook). The Temporal Response Function was used to estimate CTenv in the delta (associated with word- and phrase-level properties), theta (syllable-level properties), and alpha bands (attention-related properties). CTenv estimates were used to predict aphasia severity, performance in rhythmic perception and production tasks, and treatment response in a sentence-level rhythm-based intervention.
Results
CTenv in delta and theta, but not alpha, predicted aphasia severity. Neither CTenv in delta, alpha, or theta bands predicted performance in rhythmic perception or production tasks. Some evidence supported that CTenv in theta could predict sentence-level learning in aphasia, but alpha and delta did not.
Conclusion
CTenv of the syllable-level properties was relatively preserved in individuals with less language impairment. In contrast, higher encoding of word- and phrase-level properties was relatively impaired and was predictive of more severe language impairments. CTenv and treatment response to sentence-level rhythm-based interventions need to be further investigated.
... Most relevant to the current work, melodic intonation therapy (MIT) incorporates a simple melody, slowed tempo, and rhythmic tapping to support speech production. In adults with aphasia, there is evidence that the rhythmic, rather than the melodic, aspect of MIT provides the biggest benefit to patients (e.g., Kershenbaum et al., 2019;Stahl et al., 2011), particularly in patients with intact entrainment (Curtis et al., 2020). MIT has been used with children with CAS with mixed findings (Helfrich-Miller, 1994;LaGasse, 2012). ...
Purpose
Rhythm is one procedural mechanism that underlies language and motor skill acquisition and has been implicated in children with childhood apraxia of speech (CAS). The purpose of this study is to investigate manual rhythmic sequencing skills in children with a history of or current CAS (hx/CAS) compared to children with typical development (TD).
Method
Thirty-eight children (18 with hx/CAS, 20 with TD), ages 5;0–12;8 (years;months), from across the United States participated in an online study. Participants imitated two rhythms in two different conditions, clapping and tapping. We assessed overall accuracy, mean number of beats, pause marking, and rhythmic sequence variability using the Mann–Whitney U test. Effect sizes were calculated to examine the influence of coordinative complexity on performance.
Results
Compared to children with TD, children with hx/CAS marked fewer trials with a pause in both conditions of the easier rhythm and showed lower overall accuracy and more variable rhythmic sequences in both rhythms and conditions. The mean number of beats produced by children with hx/CAS and children with TD did not differ in three out of four rhythms/conditions. Unlike children with TD, children with hx/CAS showed little improvement from clapping to tapping across most dependent measures; reducing coordination demands did not improve performance in children with hx/CAS.
Conclusions
We found that children with hx/CAS show manual rhythmic deficits that are similar to the deficits they display in speech. These findings provide support for a domain-general cognitive mechanisms account of the rhythmic deficits observed across linguistic and nonlinguistic tasks in children with hx/CAS.
Supplemental Material
https://doi.org/10.23641/asha.24052821
Music interventions address multiple areas of stroke rehabilitation, including motor recovery, cognition, expressive language, emotional well-being, and social participation. Interventions have included music listening, rhythmic cues, playing musical instruments, Melodic Intonation Therapy, and singing. Several music intervention studies support functional recovery gains comparable to or greater than those achieved with conventional rehabilitation, but with the added benefit of enhancing mood. The neural mechanisms of music interventions continue to be investigated. Some studies have demonstrated increased functional gains associated with increased activation of affected brain areas, while other interventions engage the contralateral hemisphere. These different mechanisms may relate to the type and extent of impairment but indicate that music effectively promotes neural reorganization to support recovery. Finally, technological advances show promise for increasing accessibility and providing feedback during music interventions.
There is a long history of behavioral interventions for poststroke aphasia with hundreds of studies supporting the benefits of aphasia treatment. However, interventions for aphasia are complex with many interacting components, and no one treatment is appropriate for all persons with aphasia. We present a novel, simple framework for classifying aphasia interventions. The framework is incorporated within the overarching International Classification of Functioning, Disability, and Health (ICF) model and is consistent with the commonly-held definition that aphasia is a multimodality disorder that impairs, in varying degrees, the understanding and expression of both oral and written language modalities. Furthermore, within the language impairment level, it distinguishes between the linguistic areas of phonology, semantics, and syntax that may be impaired individually or in combination. We define the terminology of the proposed framework and then categorize some common examples of behavioral interventions for post-stroke aphasia. We describe some of these interventions in greater detail to illustrate the extensive toolbox of evidence-based treatments for aphasia. We address some key issues that clinicians, usually speech-language pathologists, consider when selecting interventions for their specific patients with aphasia, including dose. Finally, we address various models of service delivery for persons with aphasia such as Intensive Comprehensive Aphasia Programs (ICAPs) and Aphasia Centers.
Introduction: Neurorehabilitation therapy is crucial to improving functionality in patients with stroke or with such neurodegenerative diseases as dementia. In recent years, music therapy (i.e., the use of music for therapeutic purposes) has been described as an alternative tool that significantly improves motor and cognitive functions in patients with stroke or dementia. However, it has not yet been routinely implemented in clinical practice. Therefore, there is a need to review the current evidence on the positive effects of music therapy in rehabilitation and the changes it causes in the brain, particularly in patients with stroke or dementia. Methods: We conducted a literature review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and included studies published between 2010 and 2019 on the PubMed, ScienceDirect, and Web of Science databases. Results: A total of 29 articles met the inclusion and exclusion criteria and were included in this literature review. The studies selected confirm that music therapy has a positive impact on such cognitive domains as memory, attention, and language in patients with aphasia due to stroke or dementia. This therapy increases neural connectivity and cortical thickness in frontal, parietal, and temporal regions, and even in the insular cortex. Conclusion: Music therapy causes structural changes in the brain that have a favourable impact on cognition. In patients with stroke, these improvements occur during both acute and chronic stages. In the case of dementia, in contrast, the effects of music therapy are only observed in patients with mild to moderate dementia.
Melodic Intonation Therapy (MIT) is a language production therapy for severely non-fluent aphasic patients using melodic intoning and rhythm to restore language. Although many studies have reported its beneficial effects on language production, randomized controlled trials (RCT) examining the efficacy of MIT are rare. In an earlier publication, we presented the results of an RCT on MIT in subacute aphasia and found that MIT was effective on trained and untrained items. Further, we observed a clear trend in improved functional language use after MIT: subacute aphasic patients receiving MIT improved considerably on language tasks measuring connected speech and daily life verbal communication. Here, we present the results of a pilot RCT on MIT in chronic aphasia and compare these to the results observed in subacute aphasia. We used a multicenter waiting-list RCT design. Patients with chronic (>1 year) post-stroke aphasia were randomly allocated to the experimental group (6 weeks MIT) or to the control group (6 weeks no intervention followed by 6 weeks MIT). Assessments were done at baseline (T1), after 6 weeks (T2), and 6 weeks later (T3). Efficacy was evaluated at T2 using univariable linear regression analyses. Outcome measures were chosen to examine several levels of therapy success: improvement on trained items, generalization to untrained items, and generalization to verbal communication. Of 17 included patients, 10 were allocated to the experimental condition and 7 to the control condition. MIT significantly improved repetition of trained items (β = 13.32, p = 0.02). This effect did not remain stable at follow-up assessment. In contrast to earlier studies, we found only a limited and temporary effect of MIT, without generalization to untrained material or to functional communication. The results further suggest that the effect of MIT in chronic aphasia is more restricted than its effect in earlier stages post stroke. This is in line with studies showing larger effects of aphasia therapy in earlier compared to later stages post stroke. The study was designed as an RCT, but was underpowered. The results therefore have to be interpreted cautiously and future larger studies are needed.
Clinical Trial Registration: www.ClinicalTrials.gov, identifier NTR 1961.
Purpose
In this study, the authors tested whether people with aphasia (PWAs) show an impaired ability to process rhythm, both in terms of perception and production.
Method
Two experiments were conducted. In Experiment 1, 16 PWAs and 15 age-matched control participants performed 3 rhythm tasks: tapping along to short rhythms, tapping these same rhythms from memory immediately after presentation, and making same–different judgments about pairs of tapped rhythms that they heard. Comparison tasks measured same–different judgment ability with visual stimuli and nonverbal working memory (Corsi blocks). In Experiment 2, 14 PWAs and 16 control participants made same–different judgments for pairs of auditory stimuli that differed in terms of rhythm or pitch (for comparison).
Results
In Experiment 1, PWAs performed worse than control participants across most measures of rhythm processing. In contrast, PWAs and control participants did not differ in their performance on the comparison tasks. In Experiment 2, the PWAs performed worse than control participants across all conditions but with a more marked deficit in stimulus pairs that differed in rhythm than in those that differed in pitch.
Conclusions
The results support the hypothesis that at least some PWAs exhibit deficits of rhythm and timing. This may have implications for treatments involving tapping or other rhythmic cues.
Melodic intonation therapy (MIT) is a structured protocol for language rehabilitation in people with Broca’s aphasia. The main particularity of MIT is the use of intoned speech, a technique in which the clinician stylizes the prosody of short sentences using simple pitch and rhythm patterns. In the original MIT protocol, patients must repeat diverse sentences in order to espouse this way of speaking, with the goal of improving their natural, connected speech. MIT has long been regarded as a promising treatment but its mechanisms are still debated. Recent work showed that rhythm plays a key role in variations of MIT, leading to consider the use of pitch as relatively unnecessary in MIT. Our study primarily aimed to assess the relative contribution of rhythm and pitch in MIT’s generalization effect to non-trained stimuli and to connected speech. We compared a melodic therapy (with pitch and rhythm) to a rhythmic therapy (with rhythm only) and to a normally spoken therapy (without melodic elements). Three participants with chronic post-stroke Broca’s aphasia underwent the treatments in hourly sessions, 3 days per week for 6 weeks, in a cross-over design. The informativeness of connected speech, speech accuracy of trained and non-trained sentences, motor-speech agility, and mood was assessed before and after the treatments. The results show that the three treatments improved speech accuracy in trained sentences, but that the combination of rhythm and pitch elicited the strongest generalization effect both to non-trained stimuli and connected speech. No significant change was measured in motor-speech agility or mood measures with either treatment. The results emphasize the beneficial effect of both rhythm and pitch in the efficacy of original MIT on connected speech, an outcome of primary clinical importance in aphasia therapy.
Singing has been used in language rehabilitation for decades, yet controversy remains over its effectiveness and mechanisms of action. Melodic Intonation Therapy (MIT) is the most well-known singing-based therapy; however, speculation surrounds when and how it might improve outcomes in aphasia and other language disorders. While positive treatment effects have been variously attributed to different MIT components, including melody, rhythm, hand-tapping, and the choral nature of the singing, there is uncertainty about the components that are truly necessary and beneficial. Moreover, the mechanisms by which the components operate are not well understood. Within the literature to date, proposed mechanisms can be broadly grouped into four categories: (1) neuroplastic reorganization of language function, (2) activation of the mirror neuron system and multimodal integration, (3) utilization of shared or specific features of music and language, and (4) motivation and mood. In this paper, we review available evidence for each mechanism and propose that these mechanisms are not mutually exclusive, but rather represent different levels of explanation, reflecting the neurobiological, cognitive, and emotional effects of MIT. Thus, instead of competing, each of these mechanisms may contribute to language rehabilitation, with a better understanding of their relative roles and interactions allowing the design of protocols that maximize the effectiveness of singing therapy for aphasia.
We present a critical review of the literature on melodic intonation therapy (MIT), one of the most formalized treatments used by speech-language therapist in Broca’s aphasia. We suggest basic clarifications to enhance the scientific support of this promising treatment. First, therapeutic protocols using singing as a speech facilitation technique are not necessarily MIT. The goal of MIT is to restore propositional speech. The rationale is that patients can learn a new way to speak through singing by using language-capable regions of the right cerebral hemisphere. Eventually, patients are supposed to use this way of speaking permanently but not to sing overtly. We argue that many treatment programs covered in systematic reviews on MIT’s efficacy do not match MIT’s therapeutic goal and rationale. Critically, we identified two main variations of MIT: the French thérapie mélodique et rythmée (TMR) that trains patients to use singing overtly as a facilitation technique in case of speech struggle and palliative versions of MIT that help patients with the most severe expressive deficits produce a limited set of useful, readymade phrases. Second, we distinguish between the immediate effect of singing on speech production and the long-term effect of the entire program on language recovery. Many results in the MIT literature can be explained by this temporal perspective. Finally, we propose that MIT can be viewed as a treatment of apraxia of speech more than aphasia. This issue should be explored in future experimental studies.
There is an ongoing debate as to whether singing helps left-hemispheric stroke patients recover from non-fluent aphasia through stimulation of the right hemisphere. According to recent work, it may not be singing itself that aids speech production in non-fluent aphasic patients, but rhythm and lyric type. However, the long-term effects of melody and rhythm on speech recovery are largely unknown. In the current experiment, we tested 15 patients with chronic non-fluent aphasia who underwent either singing therapy, rhythmic therapy, or standard speech therapy. The experiment controlled for phonatory quality, vocal frequency variability, pitch accuracy, syllable duration, phonetic complexity and other influences, such as the acoustic setting and learning effects induced by the testing itself. The results provide the first evidence that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia. This finding may challenge the view that singing causes a transfer of language function from the left to the right hemisphere. Instead, both singing and rhythmic therapy patients made good progress in the production of common, formulaic phrases—known to be supported by right corticostriatal brain areas. This progress occurred at an early stage of both therapies and was stable over time. Conversely, patients receiving standard therapy made less progress in the production of formulaic phrases. They did, however, improve their production of non-formulaic speech, in contrast to singing and rhythmic therapy patients, who did not. In light of these results, it may be worth considering the combined use of standard therapy and the training of formulaic phrases, whether sung or rhythmically spoken. Standard therapy may engage, in particular, left perilesional brain regions, while training of formulaic phrases may open new ways of tapping into right-hemisphere language resources—even without singing.
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Background: One class of methods used in the treatment of apraxia of speech is based on rhythmic stimulation. Controlled trials investigating the effectiveness of these methods are still rare.This study, which was part of the PhD thesis of the first author (Brendel, 2003), was approved by the ethics committee of the Bayerische Ärztekammer, Munich. The first author was supported by DFG grant Zi 469/4‐1/4‐2. We are indebted to the speech‐language team of the Neuropsychological Department of the City Hospital Bogenhausen.Aims: To examine the effectiveness of a new treatment of apraxia of speech based on a metrical pacing technique (MPT) with acoustic stimulation.Methods & Procedures: MPT was applied to 10 patients with apraxia of speech. Conventional, non‐rhythmic therapeutic techniques were used as a control treatment (cross‐over design). Therapeutic effects were measured by variables describing speech rate, fluency, and segmental accuracy of sentence production. Corrections for spontaneous recovery were based on estimates inferred from a baseline period. Group statistics and multiple single case statistics were performed.Outcomes & Results: The complete intervention (MPT plus control treatment) yielded significant improvements in speech rate, fluency, and segmental accuracy. Regarding rate and fluency, MPT was superior to the control treatment. Regarding segmental accuracy, both treatments yielded comparable benefits.Conclusions: In a sample of 10 patients apraxia of speech could be modulated by behavioural treatment methods. The Metrical Pacing Therapy yielded specific improvements of rate and fluency, but also of segmental accuracy, which exceeded the effects of spontaneous recovery.
Purpose
This study was designed to further elucidate the relationship between cognition and aphasia, with a focus on attention. It was hypothesized that individuals with aphasia would display variable deficit patterns on tests of attention and other cognitive functions and that their attention deficits, particularly those of complex attention functions, would be related to their language and communication status.
Method
A group of individuals with varying types and severity of aphasia and a group of age- and education-matched adults with no brain damage completed tests of attention, short-term and working memory, and executive functioning.
Results
Overall, the group with aphasia performed significantly more poorly than the control group on the cognitive measures but displayed variability in the presence, types, and severity of their attention and other cognitive deficits. Correlational and regression analyses yielded significant relations between participants' attention deficits and their language and communication status.
Conclusion
The findings accorded well with prior research identifying (a) attention and other cognitive deficits in most but not all individuals with aphasia; (b) heterogeneity in the types and severity of attention and other cognitive symptoms among individuals with cognitive impairments; and (c) potent associations among attention, language, and other cognitive domains. Implications for clinical practice and future research are discussed.
This article describes the state of the art of Melodic Intonation Therapy (MIT), a structured aphasia therapy program using the melodic aspects of language (intonation, rhythm, and stress) to improve language production. MIT was developed in the 1970s and is still used worldwide. Nevertheless, we argue that many questions crucial for the clinical application of MIT are still unanswered. First, a review of MIT effect studies is presented showing that evidence from well-designed group studies is still lacking. It is also unclear which aspects of MIT contribute most to its therapeutic effect and which underlying neural mechanisms are involved. Two cases are presented illustrating unsolved questions concerning MIT in clinical practice, such as candidacy and the best timing of this therapy.
The question of whether singing may be helpful for stroke patients with non-fluent aphasia has been debated for many years. However, the role of rhythm in speech recovery appears to have been neglected. In the current lesion study, we aimed to assess the relative importance of melody and rhythm for speech production in 17 non-fluent aphasics. Furthermore, we systematically alternated the lyrics to test for the influence of long-term memory and preserved motor automaticity in formulaic expressions. We controlled for vocal frequency variability, pitch accuracy, rhythmicity, syllable duration, phonetic complexity and other relevant factors, such as learning effects or the acoustic setting. Contrary to some opinion, our data suggest that singing may not be decisive for speech production in non-fluent aphasics. Instead, our results indicate that rhythm may be crucial, particularly for patients with lesions including the basal ganglia. Among the patients we studied, basal ganglia lesions accounted for more than 50% of the variance related to rhythmicity. Our findings therefore suggest that benefits typically attributed to melodic intoning in the past could actually have their roots in rhythm. Moreover, our data indicate that lyric production in non-fluent aphasics may be strongly mediated by long-term memory and motor automaticity, irrespective of whether lyrics are sung or spoken.
The urge to move in response to music, combined with the positive affect associated with the coupling of sensory and motor processes while engaging with music (referred to as sensorimotor coupling) in a seemingly effortless way, is commonly described as the feeling of being in the groove. Here, we systematically explore this compelling phenomenon in a population of young adults. We utilize multiple levels of analysis, comprising phenomenological, behavioral, and computational techniques. Specifically, we show (a) that the concept of the groove is widely appreciated and understood in terms of a pleasurable drive toward action, (b) that a broad range of musical excerpts can be appraised reliably for the degree of perceived groove, (c) that the degree of experienced groove is inversely related to experienced difficulty of bimanual sensorimotor coupling under tapping regimes with varying levels of expressive constraint, (d) that high-groove stimuli elicit spontaneous rhythmic movements, and (e) that quantifiable measures of the quality of sensorimotor coupling predict the degree of experienced groove. Our results complement traditional discourse regarding the groove, which has tended to take the psychological phenomenon for granted and has focused instead on the musical and especially the rhythmic qualities of particular genres of music that lead to the perception of groove. We conclude that groove can be treated as a psychological construct and model system that allows for experimental exploration of the relationship between sensorimotor coupling with music and emotion.
We all have a sense of time. Yet, there are no sensory receptors specifically dedicated for perceiving time. It is an almost uniquely intangible sensation: we cannot see time in the way that we see color, shape, or even location. So how is time represented in the brain? We explore the neural substrates of metrical representations of time such as duration estimation (explicit timing) or temporal expectation (implicit timing). Basal ganglia (BG), supplementary motor area, cerebellum, and prefrontal cortex have all been linked to the explicit estimation of duration. However, each region may have a functionally discrete role and will be differentially implicated depending upon task context. Among these, the dorsal striatum of the BG and, more specifically, its ascending nigrostriatal dopaminergic pathway seems to be the most crucial of these regions, as shown by converging functional neuroimaging, neuropsychological, and psychopharmacological investigations in humans, as well as lesion and pharmacological studies in animals. Moreover, neuronal firing rates in both striatal and interconnected frontal areas vary as a function of duration, suggesting a neurophysiological mechanism for the representation of time in the brain, with the excitatory-inhibitory balance of interactions among distinct subtypes of striatal neuron serving to fine-tune temporal accuracy and precision.
Five nonfhient aphasics were presented English phrases with three syllable durations; a regular speech, non-intoned duration < 1 sec per syllable, and two modified Melodic Intonation Therapy (MIT) intoned durations of 1.5 sec per syllable and 2.0 sec per syllable. All subjects had the greatest number of correct phrase productions at the longest MIT duration (p < 0.001) and the greatest number of failures at the regular non-intoned duration. Therefore, syllable duration is an important acoustic parameter to consider when using an MIT technique with severe nonfluent aphasics.
Melody processing in unilaterally brain-damaged patients was investigated by manipulating the availability of contour and metre for discrimination in melodies varying, respectively, on the pitch dimension and the temporal dimension. On the pitch dimension, right brain-damaged patients, in contrast to left brain-damaged patients and normal controls, were found to be little affected by the availability of contour as a discrimination cue. However, both brain-damaged groups were impaired on tasks requiring consideration of pitch interval structure. These findings are consistent with hierarchical contribution of the cerebral hemispheres, with the right hemisphere being primary in representing the melody in terms of its global contour and the left hemisphere by filling in the intervallic structure. On the temporal dimension, only the discrimination of durational values (the rhythm) was found to be impaired by a lesion in either hemisphere, which spared, however, the metric interpretation of the musical sequences. These latter results are discussed in the light of current models of temporal processing. Finally, evidence of double dissociation between the processing of the pitch dimension and the processing of rhythm was obtained, providing further support for the need to fractionate musical perceptual abilities in order to arrive at a theory as to how the two hemispheres cohere to produce a musical interpretation of the auditory input.
A standardized rule-based scoring system, the Correct Information Unit (CIU) analysis, was used to evaluate the informativeness and efficiency of the connected speech of 20 non-brain-damaged adults and 20 adults with aphasia in response to 10 elicitation stimuli. The interjudge reliability of the scoring system proved to be high, as did the session-to-session stability of performance on measures. There was a significant difference between the non-brain-damaged and aphasic speakers on each of the five measures derived from CIU and word counts. However, the three calculated measures (words per minute, percent CIUs, and CIUs per minute) more dependably separated aphasic from non-brain-damaged speakers on an individual basis than the two counts (number of words and number of CIUs).
We used positron emission tomography to examine the response of human auditory cortex to spectral and temporal variation. Volunteers listened to sequences derived from a standard stimulus, consisting of two pure tones separated by one octave alternating with a random duty cycle. In one series of five scans, spectral information (tone spacing) remained constant while speed of alternation was doubled at each level. In another five scans, speed was kept constant while the number of tones sampled within the octave was doubled at each level, resulting in increasingly fine frequency differences. Results indicated that (i) the core auditory cortex in both hemispheres responded to temporal variation, while the anterior superior temporal areas bilaterally responded to the spectral variation; and (ii) responses to the temporal features were weighted towards the left, while responses to the spectral features were weighted towards the right. These findings confirm the specialization of the left-hemisphere auditory cortex for rapid temporal processing, and indicate that core areas are especially involved in these processes. The results also indicate a complementary hemispheric specialization in right-hemisphere belt cortical areas for spectral processing. The data provide a unifying framework to explain hemispheric asymmetries in processing speech and tonal patterns. We propose that differences exist in the temporal and spectral resolution of corresponding fields in the two hemispheres, and that they may be related to anatomical hemispheric asymmetries in myelination and spacing of cortical columns.
Four experiments explored the hypothesis that temporal processes may be represented and controlled explicitly or implicitly. Tasks hypothesized to require explicit timing were duration discrimination, tapping, and intermittent circle drawing. In contrast, it was hypothesized that timing control during continuous circle drawing does not rely on an explicit temporal representation; rather, temporal control is an emergent property of other control processes (i.e., timing is controlled implicitly). Temporal consistency on the tapping and intermittent drawing tasks was related, and performance on both of these tasks was correlated with temporal acuity on an auditory duration discrimination task. However, timing variability of these 3 tasks was not correlated with timing variability of continuous circle drawing. These results support the hypothesized distinction between explicit and implicit temporal representations.
Multiple disorders of musical abilities can occur after brain damage. Conversely, early brain anomalies or vast brain injuries may sometimes spare ordinary musical skills in individuals who experience severe cognitive losses. To document these incidences, comprehensive behavioral testing is required. We propose to use the Montreal Battery of Evaluation of Amusia (MBEA) because it is arguably the best tool currently available. Over the last decade, this battery was developed and validated in populations with brain damage of various etiologies. Furthermore, the MBEA is theoretically motivated and satisfies important psychometric properties. It is sensitive, normally distributed, reliable on test-retest, and correlates with Gordon's Musical Aptitude Profile, another more widely used battery of tests. To promote its wide usage, the MBEA is now available upon request. In addition, individual MBEA data of 160 normal participants of variable age and education have been made available to all via the internet.
The mandate for evidence-based practice has prompted careful consideration of the weight of the scientific evidence regarding the therapeutic value of various clinical treatments. In the field of aphasia, a large number of single-subject research studies have been conducted, providing clinical outcome data that are potentially useful for clinicians and researchers; however, it has been difficult to discern the relative potency of these treatments in a standardized manner. In this paper we describe an approach to quantify treatment outcomes for single-subject research studies using effect sizes. These values provide a means to compare treatment outcomes within and between individuals, as well as to compare the relative strength of various treatments. Effect sizes also can be aggregated in order to conduct meta-analyses of specific treatment approaches. Consideration is given to optimizing research designs and providing adequate data so that the value of treatment research is maximized.
Motor synchronization to the beat of an auditory sequence (e.g., a metronome or music) is widespread in humans. However, some individuals show poor synchronization and impoverished beat perception. This condition, termed “beat deafness”, has been linked to a perceptual deficit in beat tracking. Here we present single-case evidence (L.A. and L.C.) that poor beat tracking does not have to entail poor synchronization. In a first Experiment, L.A., L.C., and a third case (L.V.) were submitted to the Battery for The Assessment of Auditory Sensorimotor and Timing Abilities (BAASTA), which includes both perceptual and sensorimotor tasks. Compared to a control group, L.A. and L.C. performed poorly on rhythm perception tasks, such as detecting time shifts in a regular sequence, or estimating whether a metronome is aligned to the beat of the music or not. Yet, they could tap to the beat of the same stimuli. L.V. showed impairments in both beat perception and tapping. In a second Experiment, we tested whether L.A., L.C., and L.V.’s perceptual deficits extend to an implicit timing task, in which they had to respond as fast as possible to a different target pitch after a sequence of standard tones. The three beat-deaf participants benefited similarly to controls from a regular temporal pattern in detecting the pitch target. The fact that synchronization to a beat can occur in the presence of poor perception shows that perception and action can dissociate in explicit timing tasks. Beat tracking afforded by implicit timing mechanisms is likely to support spared synchronization to the beat in some beat-deaf participants. This finding suggests that separate pathways may subserve beat perception depending on the explicit/implicit nature of a task in a sample of beat-deaf participants.
A number of studies have identified impairments in one or more types/aspects of attention processing in patients with aphasia (PWA) relative to healthy controls; person-to-person variability in performance on attention tasks within the PWA group has also been noted. Studies using non-linguistic stimuli have found evidence that attention is impaired in this population even in the absence of language processing. An underlying impairment in non-linguistic, or domain-general, attention processing could have implications for the ability of PWA to attend during therapy sessions, which in turn could impact long-term treatment outcomes. With this in mind, this study aimed to systematically examine the effect of task complexity on reaction time (RT) during a non-linguistic attention task, in both PWA and controls. Additional goals were to assess the effect of task complexity on between-session intra-individual variability (BS-IIV) in RT and to examine inter-individual differences in BS-IIV. Eighteen PWA and five age-matched neurologically healthy controls each completed a novel computerized non-linguistic attention task measuring five types of attention on each of four different non-consecutive days. A significant effect of task complexity on both RT and BS-IIV in RT was found for the PWA group, whereas the control group showed a significant effect of task complexity on RT but not on BS-IIV in RT. Finally, in addition to these group-level findings, it was noted that different patients exhibited different patterns of BS-IIV, indicating the existence of inter-individual variability in BS-IIV within the PWA group. Results may have implications for session-to-session fluctuations in attention during language testing and therapy for PWA.
This study examines the effects of tonal and rhythmic components of a melody-based intervention on the repetition abilities of two individuals with non-fluent aphasia. The subjects presented lesions restricted to the left hemisphere and showed moderate to severe limitations on repetition tasks. An alternate-treatment design was used where pre-recorded stimuli served to guide a therapist's production of models in treatment conditions emphasising the tonal or rhythmic attributes of target utterances. The results show that, relative to baseline performance, treatment emphasising the tonal attributes of target phrases had little or no impact on the subjects' immediate or deferred repetitions of the phrases. By comparison, exercises emphasising rhythm corresponded to substantial gains in the subjects' ability to repeat target utterances. Implications are drawn with respect to the rationale of melody-based therapies, specifically on the assumption that a right-hemisphere processing of tone may facilitate fluent speech.
Background: Melodic Intonation Therapy (MIT) is a therapeutic approach used to increase verbal output in adults with aphasia through combination of melodic intoning and rhythmic tapping with simple phrase production. Although MIT was developed in the 1970s, few studies have been conducted relative to determining the programme's overall effectiveness as well as examining ability to generalise skills to other communicative contexts.Aims: The purpose of the current investigation was to examine the effectiveness of MIT as a means of increasing verbal output in a gentleman with chronic Broca's aphasia.Methods & Procedures: A modified version of MIT without the tapping component was implemented with BR, 69-year-old male with chronic Broca's aphasia of 4 years' duration. BR had tried MIT previously with little success: he had difficulty with the tapping element and the packaged phrases lacked functionality, adversely affecting his motivation. A set of automatic and self-generated phrases were developed and implemented with a multiple baseline design across phrase type with an established criterion of 75% accuracy over two consecutive sessions for both stimulus sets. Generalisation stimuli were presented at the last weekly session. BR attended three hour-long weekly sessions, for 8 weeks. Follow-up probing with all stimuli occurred at 2 and 4 weeks post-treatment. A set of standardised tests and social validation measures were administered pre- and post-treatment.Outcomes & Results: BR reached 75% accuracy on automatic phrases at 4 weeks into the treatment programme, which was retained throughout the maintenance phase and both follow-up sessions. Performance on self-generated phrases was 55% at 8 weeks -post-treatment, which was maintained at both follow-up sessions. Separate Welch two s-ample t-tests used to analyse the automatic and self-generated phrase data, yielded highly significant treatment effects for both data sets, with non-significant findings for autocorrelation. Improved performance on standardised tests was observed most no-tably for auditory comprehension and reading and writing skills, with some improvement in spontaneous speech and naming. Increased perception of communicative effectiveness was reported independently by both BR and his spouse.Conclusions: Overall, BR significantly increased his ability to produce short phrases using MIT without tapping. Thus MIT appears to be a viable option for enhancing verbal output for some individuals with non-fluent aphasia, regardless of time post-stroke. Additional investigations are needed to examine generalisation effects to other linguistic contexts. Efficiency issues (treatment length, intensity) require further exploration relative to MIT efficacy and effectiveness and its variations.
A speaker with apraxia of speech and aphasia was trained to produce multisyllabic words using a combination of metronomic rate control and hand-tapping. A multiple baseline design was used to examine the effects of treatment on sound production. Treatment was applied to three syllable words with primary stress on the first syllable while generalization was measured to: (1) untrained exemplars; (2) three syllable words with different stress patterns; (3) four syllable words; and (4) s-blend words. Positive sound changes were noted for trained and untrained words. Treatment was extended to a second set of words to which generalization had been incomplete and additional improvement was observed.
Background: A primary feature of acquired apraxia of speech (AOS) is a slow speech rate associated with lengthened sound segments and intersegment durations (McNeil, Robin, & Schmidt, 1997). This disturbance in speech production timing has been the focus of a limited number of treatment studies designed to manipulate rate and/or rhythm of speech production with speakers with mild AOS. Aims: The purpose of this investigation was to study the effects of rate control treatment on sound production accuracy and utterance durations of multisyllabic words, phrases, and sentences in a speaker with mild AOS and aphasia. Methods & Procedures: An individual with mild AOS and aphasia was trained to produce multisyllabic words and phrases using a combination of metronomic rate control and hand tapping. The speaker was trained to produce one syllable per beat of the metronome in conjunction with hand tapping. Feedback was only provided for accuracy of hand tapping and/or syllable production to the beat of the metronome. No feedback was given regarding the accuracy of sound production. Initially, the speaker's rate of production was reduced, but was then systematically increased. A multiple baseline design was used to examine the acquisition, response generalisation, and maintenance effects of treatment. Outcomes & Results: Findings revealed an increase in sound production accuracy for trained four-syllable words and some improvement in sound production accuracy for treated phrases and untrained four-syllable words. There was only a slight reduction in total utterance duration for treated items versus untreated items. There was a gradual decline in total utterance duration over time on untrained stimulus generalisation items with no consistent improvement on sound production accuracy. Conclusions: Treatment resulted in an improvement in sound production accuracy in an individual with AOS and aphasia. Positive changes were observed for treated four-syllable words, phrases, and untrained four-syllable words, although treatment did not directly target sound production accuracy (i.e., feedback was not given regarding accuracy of productions). The study represents an initial investigation of the effects of rate control treatment specifically increasing rate of production in a speaker with mild AOS and aphasia. This type of treatment appears to have promise in terms of improving sound production accuracy and warrants further investigation.
This report provides a summary and critical appraisal of the evidence utilized in the development of treatment guidelines for acquired apraxia of speech (AOS). This systematic review of the AOS treatment literature is a result of the efforts of the Academy of Neurologic Communication Disorders and Sciences (ANCDS) Writing Committee of Treatment Guidelines for AOS. Fifty-nine publications that met inclusion criteria were reviewed in terms of 33 variables pertaining to issues such as subject, treatment, and outcome descriptions, and scientific adequacy. Although the review revealed many weaknesses in the evidence base, findings indicated that patients with AOS can benefit from treatment.
For more than 100 years, clinicians have noted that patients with nonfluent aphasia are capable of singing words that they cannot speak. Thus, the use of melody and rhythm has long been recommended for improving aphasic patients' fluency, but it was not until 1973 that a music-based treatment [Melodic Intonation Therapy (MIT)] was developed. Our ongoing investigation of MIT's efficacy has provided valuable insight into this therapy's effect on language recovery. Here we share those observations, our additions to the protocol that aim to enhance MIT's benefit, and the rationale that supports them.
Explicit timing is engaged whenever subjects make a deliberate estimate of discrete duration in order to compare it with a previously memorised standard. Conversely, implicit timing is engaged, even without a specific instruction to time, whenever sensorimotor information is temporally structured and can be used to predict the duration of future events. Both emergent timing (motor) and temporal expectation (perceptual) are forms of implicit timing. Recent fMRI studies demonstrate discrete neural substrates for explicit and implicit timing. Specifically, basal ganglia are activated almost invariably by explicit timing, with co-activation of prefrontal, premotor and cerebellar areas being more context-dependent. Conversely, implicit perceptual timing (or "temporal expectation") recruits cortical action circuits, comprising inferior parietal and premotor areas, highlighting its role in the optimisation of prospective behaviour.
The purpose of this retrospective study was to investigate the relationship between CT scan lesion localization and good or poor response to Melodic Intonation Therapy (MIT) as measured by pre- and post-MIT treatment scores. The four good response (GR) cases improved in speech characteristics ratings for Phrase Length and Grammatical Form on the Boston Diagnostic Aphasia Examination; the four poor response (PR) cases showed no improvement. The GR cases had lesions which involved Broca's area and/or white matter deep to it plus large superior lesion extension into periventricular white matter deep to the lower motor cortex area for face. These GR cases had no large lesion in Wernicke's area and no lesion in the temporal isthmus or the right hemisphere. The PR cases, however, had bi-lateral lesions or lesion including Wernicke's area or the temporal isthmus.
A study is presented which is concerned with a new form of language therapy for aphasia, called Melodic Intonation Therapy (MIT). This program involves sung intonation of propositional sentences, in such a way that the intoned pattern is similar to the natural prosodic pattern of the sentence when it is spoken. The method and scoring system are described. Results are based on 8 severely, but not globally, impaired right handed aphasic subjects, with left hemisphere damage resulting from cerebrovascular accidents. Each patient acted as his own control by having shown no improvement in verbal expression for at least 6 mth, during which time he had received other language therapy. Recovery of some appropriate propositional language occurred for 6 of the 8 patients, as a result of MIT. It is suggested that both dominance for music, and existence of less developed language areas, in the right hemisphere are perhaps being used to support the damaged left hemisphere which continues to be language dominant. Although candidacy for MIT is still subject to further investigation, it is suggested that prerequisites should include less impaired auditory comprehension than verbal expression, evidence of self criticism, good attention span, and evidence that ongoing recovery in some language modalities has occurred or is occurring. Efficacy of MIT for chronically global aphasics is probably subject to question.
A new form of language therapy has been used successfully with aphasic patients who had severe, long term, stable defects and for whom other forms of therapy had failed. One explanation for these results suggests that latent language capacities of the nondominant hemisphere may be stimulated.
The production and perception of pitch and rhythm were tested in patients with acquired unilateral left-hemisphere (LH) lesions (and subsequent motor dysphasia, n = 13), patients with unilateral right-hemisphere (RH) lesions (n = 14), and normal age-matched controls. While the LH dysphasic subjects were not generally impaired on the production or perception of pitch, they were grossly impaired on the production and perception of rhythm. The RH subjects, in contrast, were impaired on measures of pitch perception and production, including the discrimination and production of single notes and of melodies. It is concluded that the two hemispheres differ in their specialization for the perception and production of pitch and rhythm.
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